[Hiring] LEAD MARKET APPEALS SPECIALIST @UHS

Role Description

This position supports utilization management and shared services within the behavioral health division. This role oversees and completes all standard appeals within a designated market. Additionally, this position acts as the point of contact for all staff in the market and acts as the supervisor for the Market Appeals Support Specialists in the market. A successful candidate must have knowledge of utilization management operations, including experience with appeal letters and payer engagement. The ability to apply clinical acumen in a behavioral health setting both verbally and in writing is essential to this role.

*This is a fully remote position.

Responsibilities:

• Complete all standard appeals timely and manage appeal inventory through ongoing tracking and monitoring.
• Act as a liaison with local facilities and payers to ensure timely appeal processing including appropriate follow-up with payers for facility reimbursement.
• Supervise, guide and support the Appeals Support Specialist within the Market.
• Participate in local facility UM team meetings to support the standard appeal process.
• Provide feedback to providers and UM team on opportunities impacting facility recoveries (e.g., documentation).

Qualifications

• Bachelor's degree required, Master's preferred.
• RN License or Master's level clinician required, License preferred.
• 3-5 years related experience required, 5-8 preferred.
• Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
• Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
• Strong oral communication skills to represent patient progress and treatment in behavioral health.
• Understanding of medical necessity criteria application for all levels of care.
• Ability to apply clinical acumen in behavioral health to written correspondence.

Requirements

• Bachelor's degree required, Master's preferred.
• RN License or Master's level clinician required, License preferred.
• 3-5 years related experience required, 5-8 preferred.
• Knowledge of utilization management operations, including experience with appeal letters and payer engagement.
• Proficient in Excel, Microsoft Office/Teams, Word, and database inventory management.
• Knowledge of payer requirements for reimbursement across all levels of care and behavioral health business office operations.
• Strong oral communication skills to represent patient progress and treatment in behavioral health.
• Understanding of medical necessity criteria application for all levels of care.
• Ability to apply clinical acumen in behavioral health to written correspondence.

Benefits

• UHS offers a challenging and rewarding work environment.
• Growth and development opportunities within UHS and its subsidiaries.
• Competitive Compensation.
• Excellent Medical, Dental, Vision and Prescription Drug Plan.
• 401k plan with company match.
• Generous Paid Time Off.